| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $347.10 | $451.23 | $881.38 |
Aetna
| Professional | QZ | $318.18 | $550.62 | $635.33 |
Ambetter
| Professional | AA | $122.88 | $200.60 | $621.00 |
Ambetter
| Professional | QZ | $176.53 | $210.71 | $320.95 |